I decided this could not wait. I usually delay posting until the last post has 200 pageviews. I am making an exception with this one given the timely nature of today’s presentation and my great disappointment in its substance. LZ

DoCM Grand Rounds, August 13: Science as Show Biz

By

Leonard Zwelling

With
a good deal of fanfare, Cancer Medicine Grand Rounds on August 13 was devoted
to the latest advances in cancer immunotherapy. This was particularly timely as
newer agents are being developed by drug companies and academic centers that
target the immune system itself, rather than the cancer as a way to cause the
regression of the cancer if not its cure.

For
well over a century, medicine has been seeking a way to harness the immune
system to fight cancer. The model used in infectious disease of vaccination to
prevent disease has been largely unsuccessful in oncology with the exception of
vaccines against HPV and hepatitis, infectious causes of cancer.

The
presentation from James Allison, Pam Sharma and Patrick Hwu purported to
demonstrate the newest strategy of immunotherapy in patients who had already
developed cancer. My guess is that for those in the audience familiar with the
science, this was a valuable seminar. For those like me who knew nothing about
it, this was not particularly helpful as the modern diagrams of complex
pathways that are enabled by Power Point really never addressed how the new
science was discovered and how the mechanism unearthed actually works in
people. We were assured that it does with the obligatory random CT scan and
flow patterns to prove it and survival curves with long tails indicating the
presence of some long-term survivors.

Throughout
the presentation, the speakers offered their assistance to the gathered minions
who wish to do clinical trials using this new technology and new agents coming
from pharma. They have the “platform” to make your life easy and don’t even
want any academic credit in return for their assistance. I wasn’t sure if there
was a price tag associated with the help. Problems with budgets, contracts and
protocol approval were peripherally alluded to while Dr. Hwu cheered on the
infrastructure with words of encouragement. I wasn’t quite sure if I was
listening to science, enduring a sales pitch or witnessing a large pep rally in
self-justification or even self-delusion.

I
believe that was because the speakers really hadn’t coordinated their
presentations and the only common thread among them was the technology itself
which was less than adequately described at least for my untrained eyes and
ears.

I
remember when not so long ago, the science stood on its own two feet, needing no
hucksterism or a sales pitch to make a convincing argument. It seems like those
days are gone replaced by the need for grandiose (“no small”) plans, fantastic
diagrams of pathways and cells talking to one another and a goodly dose of
rah-rah cheerleading. And people wonder why no one is taken seriously any more.

What
I saw today was a show. It was surely not a thoughtful or insightful presentation
of new scientific ideas substantiated by data. It seemed like a platform plea
for relevance as well as a cry for help recruiting clinicians to do this work.
I am not sure if it occurred to the presenters that the clinicians are doing
everything in their power just to keep their heads above water and make their
numbers rather than worry about doing any cutting edge research. Like the
haggard and multitasking woman worker in the Doonesberry comic strip many years
ago when told that half the women in America were having affairs, she asked,
“When”? Ditto our clinical people. When will they have the time to do these
studies and still keep up with their clinical loads. Of course, we could decide
that this form of work is more valuable than assembly line cancer care, but no
one expects that to occur so long as the smell of red ink permeates the
LeMaistre Clinic.

Upon
leaving the lecture I conversed with a senior faculty member who divided the
faculty into four groups.

One
group was senior faculty who are retiring. They will not protest what is
happening around them for they are leaving.

Group
two was the senior faculty who can’t quite leave yet usually because of tuition
fees and house payments. Surely they will remain silent for fear of
jeopardizing their revenue stream or needed tenure renewal.

Group
three is the mid-career group who isn’t happy at all, but has even greater
financial exigencies and cannot risk their interruption although some are
getting out.

Group
four is the newbies who don’t know a kinder, gentler more academically friendly
MD Anderson and just keep their heads down and plow on.

Notice
there is no group that is resisting the move to kill the MD Anderson of old.
And there is not likely to be even as that by-gone era is on life support.

In
The Producers on Broadway, Mel Brooks wrote:

It
ain’t no mys’try

In
politics or his’try

The
only thing I know is

Everything
is show biz

Clearly
that is true in academic oncology as well where a highly touted lecture can
deliver so little in clarity and precision and yet have everyone in the place
praising it. What happened to the

e old days when even great science was critically
battered during the Leukemia Service seminar series?

Perhaps
everyone has forgotten that we make progress through conflict and the
interchange of ideas. It’s not via being polite and, as the NAS’d and IOM’d President
has clearly shown, it sure isn’t by being nice.

Immunotherapy
is a great idea and this does sound very promising. How about let’s stick to
the science and not the ad campaign.

And
just for the record, we have a faculty member who developed a successful immunotherapeutic that targets immune cells not cancer and has been
approved in Europe and other countries around the world despite the ignorance
of the FDA obstructionists. She Heads Pediatrics.